Provider Demographics
NPI:1558579334
Name:GERALD M. KLUFT D.D.S. P.A.
Entity type:Organization
Organization Name:GERALD M. KLUFT D.D.S. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:MCELROY
Authorized Official - Last Name:KLUFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-988-1103
Mailing Address - Street 1:5208 E FOWLER AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1906
Mailing Address - Country:US
Mailing Address - Phone:813-988-1103
Mailing Address - Fax:
Practice Address - Street 1:5208 E FOWLER AVE
Practice Address - Street 2:SUITE F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1906
Practice Address - Country:US
Practice Address - Phone:813-988-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty